Visiting San Francisco General Hospital's medical emergency room or walking the streets of San Francisco and seeing untreated, seriously mentally ill people would convince most observers that the biggest problem of the mentally ill is not stigma. Yet millions of tax dollars are spent on antistigma campaigns.

Those funds might be better used to open more acute psychiatric beds so mentally disturbed people don't have to spend days strapped to a gurney in medical facilities not equipped to handle them.

This need is urgent: San Francisco has reduced the number of psychiatric beds at San Francisco General Hospital from 87 to 21 in order to cut costs. The psychiatric emergency room has become so overwhelmed with patients that the police send nearly half of the people they pick up as 5150s (shorthand for the civil code that authorizes involuntary treatment of the mentally ill) to medical emergency rooms.

Many of the mentally ill end up in jail rather than in treatment. Thus, acute bed cuts billed as savings have simply shifted costs to the criminal justice system. This will become a bigger problem as county jails, under the state's realignment policy, must take in inmates previously housed in state prisons.

California needs to revise its 45-year-old Lanterman-Petris-Short Act, a civil rights law designed to extract persons with mental illness from state hospitals with the expectation that they would receive care and treatment in their home communities. This expectation failed.

The Lanterman-Petris-Short Act often doesn't work because it only provides treatment if the person is considered imminently dangerous to him- or herself or others. The law, funded by Medi-Cal , doesn't provide treatment for mental illness per se. In the words of a front line case worker: "We can barely get folks in the hospital anymore even if the person is floridly psychotic and eating out of garbage cans."

In 2004, Californians approved Proposition 63, a mental health services law funded by a tax on millionaires. It was sold to voters as a means to rescue severely mentally ill persons from homelessness (as they are the vast majority of the homeless). A walk through downtown San Francisco would show this did not happen. More than half the money is siphoned off to grants for ancillary programs, such as antistigma programs.

Under current law, we often have to wait until a mentally ill person becomes violent in order to prove dangerousness. Then, it is too late.